Which nutritional therapist?

Nutritional therapists are a varied bunch and come in several ‘flavours’, with the science and evidence-based practitioners at one end of the spectrum and at the other, what @skepticstu on Twitter referred to as the ‘Supplement Salesforce’.

At this far end, some seem to think many ills — particularly chronic conditions — are due to dairy intolerance or wheat intolerance, or both or ‘toxins’, or ‘imbalances’, or ‘chemicals’, or deficiencies. And, of course, they have just the personalised detoxification or supplement for you to address the ‘underlying causes’ of your health issues. And they may make extensive use of iridology, hair mineral analysis and applied kinesiology tests to work out your own, optimum health, individualised, holistic, supplement plan. For a price. All major credit cards accepted.

Others, I am sure, give good, evidence-based diet advice without a supplement in sight. They are not the problem here.

Anyone can call themselves a nutritionist or nutritional therapist; no qualifications or training necessary. The advice they give might be good advice, but it’s difficult to know which end of the spectrum they are at. I suspect I’ll return to this topic at a later date, but to understand a bit about what some nutritionists are being taught, see Prof David Colquhoun’s excellent summary of what’s going on in some of our universities: The demise of quackademia.

It’s important here to point out that there is another group that offers dietary advice — Registered Dietitians — and it’s vital to understand the difference. The title Dietitian is protected; they are statutorily regulated and mainly work within the NHS. The British Dietetic Association (the professional body for Registered Dietitians) has a good guide to the differences between the different titles.

Indeed many nutritionists and nutritional therapists are at great pains to distance themselves from Dietitians. You have to wonder why.

Catherine Collins RD is Principal Dietitian at St Georges Hospital in London and one of these experts in nutrition. In reply to a comment on The Quackometer, she said of nutritionists offering quack advice about ridiculous dietary restrictions:

We would not tolerate such amateurism as pseudo-medics, pseudo-dentists, yet the appeasers would seem to accept these practitioners as if their ‘treatment’ is benign. It is time for their profession to be seriously scrutinised. If you want to practice clinical therapeutic nutrition, re-train as a dietitian. Nutritional therapists that have committed to the 4 year, full time BSc(Hons) degree are amazed at how unconciously incompetent they were in their previous career.

Which?

The highly respected consumer organisation, Which?, surveyed the advice given by nutritionists some ten years ago and they found ‘cause for concern‘.

Last year, they decided to see what, if anything, had changed and conducted another survey. They sent five researchers to see what advice nutritionists gave for a variety of medical conditions. In all, there were 15 consultations with 14 nutritionists and the advice they were given was assessed by a panel of experts.

The Which? panel of medical experts rated six of the 15 consultations as ‘dangerous fails’ – where the advice given could potentially endanger the health of the researcher.

Eight consultations were rated as ‘fails’ and one as a ‘borderline pass’.

One therapist advised our researcher, who was posing as a cancer sufferer, against having conventional treatment (a lumpectomy and radiotherapy), saying that she should try for three to six months to rid herself of the cancer through diet (by cutting out sugar).

These findings are very worrying and the public needs to be protected from such dangerous and misleading advice.

The full report is available to Which? subscribers, but a summary can be found here. Read about the use of pseudo scientific tests such as iridology and hair mineral analysis and find out what on earth a ‘leathery bowel’ is all about.

Of course, this investigation does’t show that all nutritional therapists give misleading or dangerous advice and it was a small sample. But it does indicate that there is an issue that could well have serious or even tragic consequences if it was widespread. It indicates that someone has to investigate more thoroughly and in more depth to find the true extent of the problems, and then fix them. This isn’t about faulty tumble driers or high bank interest rates: it’s about the public being given misleading or dangerous health advice.

The discussion about all this on the Which? Conversation forum has been very…emmm… interesting. No doubt used to heated discussions about credit deals, double glazing, washing machines and fuel prices I don’t think Which? knew what had hit them when they touched on the emotive topic of pseudo scienctific beliefs!

All the usual poor argumentation skills are prominent: anecdotes, straw men, appeals to antiquity, ad populam and ad hominems and the demands to know the show size of those making critical comments (OK, I made that last bit up). And of course, cherry-picking of data. All this shows is an inability to critically examine strongly-held beliefs and re-appraise in the light of good evidence. It’s just not science.

Key issues

Many nutritionists defended their training, saying they only ever practise evidence-based nutrition. Good. As I said earlier, there will be many like that, but Which? have shown that there are some who are not so well grounded in science and evidence.

Much of the negativity was aimed at the expert panel with claims that none of them knew anything about nutrition and, anyway, to be impartial, the panel should have included a nutritionist. Turkeys and Christmas springs to mind.

But most commenters failed to address the key issues of nutritionists using pseudo scientific diagnostic techniques and giving misleading and dangerous advice. Instead, we were regaled with anecdotes of how their nutritionist helped them with whatever condition they had, usually when the NHS had apparently failed them.

Whether or not the number of these was swelled by an Alliance for Natural Healthcare’s Tweet that implored supporters to skip over to the Which? discussion to deposit their favourite anecdote there, is anyone’s guess. The ANH even wrote an article (cached) about it. But what is predictable was the spin and attacks on the expert panel’s integrity and competence. However, even with their transparent diversionary tactics, the ANH realised, despite their mutual admiration (cached) for BANT (see below), that something had to be done, saying the investigation revealed ‘important issues':

Undeniably, some of the advice given by the nutritional therapists targeted by the Which? investigation gives serious cause for concern.

and

On the one hand, this Which? investigation has unearthed some awkward truths for professional bodies acting on behalf of nutritional therapists. We urge them to act quickly and decisively in order to ensure that the mistakes highlighted by Which? do not happen again – and if they do, to ensure robust disciplinary procedures are in place to deal with the culprits. All professions have their bad eggs, but what marks out a trustworthy profession is its willingness and ability to deal with them.

If their members are employing hair mineral analysis and iridology, then there’s maybe a couple of centuries needing to be deducted to make that accurate. They also claim to be:

…a professional body that aims to promote and safeguard members’ interests

I’m glad that’s clear.

BANT responded to the criticism by issuing a press release (cached), curiously, dated three days before Which? published their report. They had been aware for some time that Which? were going to publish the damning report into their members, so you’d have thought they would have taken the time to reflect on its findings. Unfortunately, they singularly failed to address the serious issues raised by the Which? investigation, instead simply whining about Which?, their research and the panel of experts.

Meanwhile, the comments continued on the Which? website.

BANT released a second press statement (cached) where they disputed some of the account Which? gave. However, unlike BANT, I don’t see their gripes as being significant. And they still didn’t address the issues or say what they were going to do about them.

Code? What Code?

The first sentence of this second press release says:

In response to the recent Which? article BANT assures the public that it is completely outside the BANT Code of Practice to advise a client to withhold any treatment for cancer for any period of time in order to follow a nutritional approach

That’s good to know.

I wonder what else is outside BANT’s Code of Practice? What else will get a BANT member into hot water? How stringent is this Code of Practice? How do they deal with complaints?

I searched their website, but there is no link to their Code of Practice. It gets mentioned several times on their membership application forms and prospective members are told they have to abide by it and will be sent a copy, but it looks like even aspiring members don’t get to see it until they’re signed up:

I agree to abide by the Code of Professional Practice Handbook – Issue 1.1 March 2011. On acceptance of my membership application, I understand that I will receive my personal copy of the Code and I agree to familiarise myself with the content within a short time of receipt. I also agree to review the content on an ongoing basis, as I understand that aspects of the Code will be updated as and when necessary and posted on: www.bant.org.uk/bant/jsp/member/professionalPractice.faces

Those updates are in the members-only section of the website.

It does seem to be all rather secretive. What’s wrong with telling the public what they can expect from one of their members?

So I emailed them. Unfortunately, after several emails back and forth, it transpired that they really weren’t that interested in publishing their Code so the public could see what their members are allowed and not allowed to do. Pity.

I also discovered that they don’t have a list of what diagnostic tests their members are allowed to use. So, unless a friendly nutritionist out there wants to send me a copy, we will probably never know what standards BANT members are supposed to meet and what they are allowed to do.

But it’s worth looking at how OfQuack define ‘Nutritional Therapy’. All we have to do is look at their ‘Discipline Descriptors‘ page. (Yep, they call nonsense like reflexology, Bowen therapy and ‘healing’, disciplines.) Except, the link to their description for nutritional therapy has been missing for months. I have a copy of the original and it is still on their website: it’s just not linked to. Like their other descriptors, it says so little as to be useless. It certainly doesn’t say, for example, what diagnostic tests it thinks are appropriate for their registrants to use and which are plain quackery. But then again, this is an organisation that ‘regulates’ reflexologists and naturopaths.

However, the new version appeared yesterday. It has been revised with the help of the Advertising Standards Authority to make it compliant with the CAP Code. This has meant, of course, that any hint of a claim that could not be substantiated with robust scientific evidence has had to be removed. It doesn’t leave much, of course, but what is there helps define what OfQuack thinks the public can expect from a nutritional therapist. What they say is interesting and I’ll publish another blog post about it shortly.

Dealing with the issues

Now that Which? and the Daily Mail have uncovered problems — even if some try to bury their heads in the sand — what happens next will define what kind of regulators the public have protecting them.

This should not be the end of the issue. Whether or not Which? are able to do any further research is up to them. However, it is now incumbent on the various trade bodies, associations and ‘regulators’ to pick up the challenge of investigating further, finding out the true extent of the misleading and dangerous advice and ensure that training and education courses are corrected; that rules and codes of practice are reviewed and strengthened; that these rules and codes are properly enforced so that the public are properly protected from these dangers, which is surely what we all want and deserve.

There are many nutritionists who are properly trained and who would not dream of offering such poor or dangerous advice. They must now use their influence to make sure that the rest fall into line and that the different representative bodies take the appropriate firm action and do not simply ignore what has been shown to be happening.

If they don’t take action, the next time this comes up might be at a coroner’s inquest. That would be tragic indeed, particularly if the problem had already been highlighted, yet no proper action taken.